Introduction: Information on the relationship between body composition and bone health among African women is scarce. We examined the association between body composition(body mass index {BMI}, fat mass and lean mass) and bone health (bone mineral density {BMD} and fracture risk) in urban black South African women. Materials and Methods: BMD and body composition were measured in 189 postmenopausal black women using dualenergy X ray absorptiometry (DXA). Questionnaires were administered to examine the socio-demographic, lifestyle, dietary intake, physical activity and fracture risk. Activity energy expenditure (AEE) was measured using an accelerometer with combined heart rate monitor. Discussion: Fat mass and lean mass were significantly associated with both BMD and fracture risk when adjusted for potential confounders. However, lean mass and not fat mass remained a significant predictor of femoral neck BMD (β= 0.49, p<0.001), spine BMD (β=0.48, p<0.0001) and hip BMD (β=0.59, p<0.0001). Lean mass was also negatively associated with fracture risk (β=−0.16 p<0.001) when both variables were taken into account. Our study shows that lean mass was a stronger predictor of femoral neck, spine and hip BMD in post-menopausal urban black South African women than fat mass, as evidenced by the finding that lean mass remained a significant predictor, while fat mass no longer predicted BMDs and fracture risk when both body composition variables were taken into account in the same model. Conclusion: Lean mass and fat mass were significant positive predictors of BMDs at all measures sites and negatively associated with fracture risk in urban black South African women. Our findings suggest that compared to fat mass, lean mass might be a stronger predictor of bone health.